Provider Demographics
NPI:1154309185
Name:GRANDE, SAMUEL F (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:F
Last Name:GRANDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5410
Mailing Address - Country:US
Mailing Address - Phone:412-824-3431
Mailing Address - Fax:412-824-1375
Practice Address - Street 1:3470 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5410
Practice Address - Country:US
Practice Address - Phone:412-824-3431
Practice Address - Fax:412-824-1375
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR1731206Medicare UPIN